<strong>Objective:</strong> To evaluate the role of invasive imaging in the identification and pre-surgical localization of endoductal breast lesions. <strong>Methods:</strong> We retrospective...<strong>Objective:</strong> To evaluate the role of invasive imaging in the identification and pre-surgical localization of endoductal breast lesions. <strong>Methods:</strong> We retrospectively evaluated cytological outcomes, non-invasive/invasive breast imaging obtained between January 2016 and December 2019 in women with pathological nipple discharge (PND). We analysed sensitivity, specificity, positive predictive value and negative predictive value. We also evaluated the advantages of a pre-surgical radiological study using an endoductal contrast medium (with 3D-technique, in young women with dense breasts). <strong>Results:</strong> A total of 286 women with PND underwent cytological examination, mammography and/or breast ultrasound. When the cytological outcome was reported as “negative” (66.78%) in agreement with negative noninvasive imaging, patients were sent to follow up. Patients with cytological outcomes defined as “bloody with papillary clusters” (29.37%) “bloody not associated to cytological modifications” (2.44%), or “atypical/suspected” for malignant (1.39%) underwent an invasive procedure. Sensitivity, specificity, positive predictive value and negative predictive value were, respectively: 92.63%, 100%, 100% and 96.46% for cytological examination;64.28%, 96.95%, 60% and 97.44% for mammography;41.11%, 97.44%, 88.09% and 78.27% for ultrasound;93.68%, 100%, 100% and 96.95% for invasive procedures. Post-surgical histological outcomes confirmed the diagnosis. <strong>Conclusion:</strong> In absence of a standard diagnostic algorithm, we recommend invasive procedures to identify intraductal breast lesions and for preoperative planning. Digital imaging and new technologies such as 3D-tomosynthesis lead to a renaissance of breast invasive imaging;they are confirmed to be an essential diagnostic modality for preoperative planning, to define localization and extension of multiple coexisting endoductal lesions.展开更多
BACKGROUND Post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis is a common complication of the procedure.The effective prevention of post-ERCP pancreatitis(PEP)remains a key focus of clinical researc...BACKGROUND Post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis is a common complication of the procedure.The effective prevention of post-ERCP pancreatitis(PEP)remains a key focus of clinical research.AIM To develop a prediction model for PEP based on multidimensional clinical indicators and evaluate its clinical application value.METHODS We retrospectively analyzed 183 patients with biliary tract diseases who underwent ERCP at Xuzhou Medical University from January 2020 to June 2023,divided into non-PEP(n=159)and PEP(n=24)groups based on PEP development.Baseline and intraoperative data were compared,and PEP-related factors examined via univariate and multivariate logistic regression.Using R,70%of patients were assigned to training and 30%to testing sets for PEP prediction model development.Model accuracy was evaluated using a calibration curve and receiver operating characteristic(ROC)area under the curve(AUC).RESULTS Age,total cholesterol level,history of pancreatitis,pancreatic ductography,bleeding,and intubation time differed significantly between the two groups when baseline data and intraoperative conditions were compared(P<0.05).Multifactorial logistic regression analysis demonstrated that age[odds ratio(OR)=0.192,95%confidence interval(CI):0.053-0.698],total cholesterol(OR=0.324,95%CI:0.152-0.694),history of pancreatitis(OR=6.159,95%CI:1.770-21.434),pancreatography(OR=3.726,95%CI:1.028-13.507),and bleeding(OR=3.059,95%CI:1.001-9.349)were independently associated with acute pancreatitis after ERCP.The predictive probabilities from the calibration curves had mean errors of 0.021 and 0.030,with ROC AUCs of 0.840 and 0.797 in the training and test sets,respectively.CONCLUSION Age,total cholesterol,pancreatitis history,pancreatic ductography,and bleeding influence the risk of acute PEP.A model incorporating these factors may aid early detection and intervention.展开更多
文摘<strong>Objective:</strong> To evaluate the role of invasive imaging in the identification and pre-surgical localization of endoductal breast lesions. <strong>Methods:</strong> We retrospectively evaluated cytological outcomes, non-invasive/invasive breast imaging obtained between January 2016 and December 2019 in women with pathological nipple discharge (PND). We analysed sensitivity, specificity, positive predictive value and negative predictive value. We also evaluated the advantages of a pre-surgical radiological study using an endoductal contrast medium (with 3D-technique, in young women with dense breasts). <strong>Results:</strong> A total of 286 women with PND underwent cytological examination, mammography and/or breast ultrasound. When the cytological outcome was reported as “negative” (66.78%) in agreement with negative noninvasive imaging, patients were sent to follow up. Patients with cytological outcomes defined as “bloody with papillary clusters” (29.37%) “bloody not associated to cytological modifications” (2.44%), or “atypical/suspected” for malignant (1.39%) underwent an invasive procedure. Sensitivity, specificity, positive predictive value and negative predictive value were, respectively: 92.63%, 100%, 100% and 96.46% for cytological examination;64.28%, 96.95%, 60% and 97.44% for mammography;41.11%, 97.44%, 88.09% and 78.27% for ultrasound;93.68%, 100%, 100% and 96.95% for invasive procedures. Post-surgical histological outcomes confirmed the diagnosis. <strong>Conclusion:</strong> In absence of a standard diagnostic algorithm, we recommend invasive procedures to identify intraductal breast lesions and for preoperative planning. Digital imaging and new technologies such as 3D-tomosynthesis lead to a renaissance of breast invasive imaging;they are confirmed to be an essential diagnostic modality for preoperative planning, to define localization and extension of multiple coexisting endoductal lesions.
文摘BACKGROUND Post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis is a common complication of the procedure.The effective prevention of post-ERCP pancreatitis(PEP)remains a key focus of clinical research.AIM To develop a prediction model for PEP based on multidimensional clinical indicators and evaluate its clinical application value.METHODS We retrospectively analyzed 183 patients with biliary tract diseases who underwent ERCP at Xuzhou Medical University from January 2020 to June 2023,divided into non-PEP(n=159)and PEP(n=24)groups based on PEP development.Baseline and intraoperative data were compared,and PEP-related factors examined via univariate and multivariate logistic regression.Using R,70%of patients were assigned to training and 30%to testing sets for PEP prediction model development.Model accuracy was evaluated using a calibration curve and receiver operating characteristic(ROC)area under the curve(AUC).RESULTS Age,total cholesterol level,history of pancreatitis,pancreatic ductography,bleeding,and intubation time differed significantly between the two groups when baseline data and intraoperative conditions were compared(P<0.05).Multifactorial logistic regression analysis demonstrated that age[odds ratio(OR)=0.192,95%confidence interval(CI):0.053-0.698],total cholesterol(OR=0.324,95%CI:0.152-0.694),history of pancreatitis(OR=6.159,95%CI:1.770-21.434),pancreatography(OR=3.726,95%CI:1.028-13.507),and bleeding(OR=3.059,95%CI:1.001-9.349)were independently associated with acute pancreatitis after ERCP.The predictive probabilities from the calibration curves had mean errors of 0.021 and 0.030,with ROC AUCs of 0.840 and 0.797 in the training and test sets,respectively.CONCLUSION Age,total cholesterol,pancreatitis history,pancreatic ductography,and bleeding influence the risk of acute PEP.A model incorporating these factors may aid early detection and intervention.
